> Table 55: Hospital volume and breast cancer survival after treatment
This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.
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Introduction: There are few U.S. studies looking at a possible link between the number of breast cancer surgeries a hospital performs each year (a measure of hospital volume) and survival after treatment [1]. The largest study (detailed below) followed nearly 48,000 women who had breast cancer surgery [2]. Those who were treated at hospitals performing more than 150 breast cancer surgeries a year were less likely to die of breast cancer within five years of their surgery than women who were treated at hospitals performing fewer surgeries. Similar results were found in two other large studies [3,4]. However, a smaller study found no difference in survival among women treated at high volume hospitals and those treated at low volume hospitals [5].
Study selection criteria: U.S. studies on hospital volume and breast cancer survival.
Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.
Study
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Study Population
(number of
women who had breast cancer surgery)
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Hospital Volume
(number of breast cancer surgeries performed per year)
|
Relative Risk of Dying from Breast Cancer within Five Years after Surgery,
RR (95% CI)
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Roohan et al. [2]
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47,890
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<10 vs. >150
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1.60 (1.42-1.81)
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|
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10-50 vs. >150
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1.30 (1.22-1.37)
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|
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50-150 vs. 150
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1.19 (1.12-1.25)
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Skinner et al. [3]
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29,666
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36-70 vs. 1-35
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0.92 (0.85-0.99)
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|
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71-125 vs. 1-35
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0.78 (0.72-0.85)
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|
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>125 vs. 1-35
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0.77 (0.70-0.84)
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Gilligan et al. [4]
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11,225
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20-39 vs. 0-19
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0.80 (0.66-0.97)
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|
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>40 vs. 0-19
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0.78 (0.64-0.96)
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Harcourt et al. [5]
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2,409
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<10 vs. >40
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1.05
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11-20 vs. >40
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0.98*
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21-30 vs. >40
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1.02
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31-40 vs. >40
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1.00
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* Results not statistically significant.
References
1. Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of care. Journal of Clinical Oncology. 18(11):2327-40, 2000.
2. Roohan PJ, Bickell NA, Baptiste MS, et al. Hospital volume differences and five-year survival from breast cancer. Am J Public Health. 88(3):454-7, 1998.
3. Skinner KA, Helsper JT, Deapen D, et al. Breast cancer: Do specialists make a difference? Ann Surg Oncol. 10(6):606-15, 2003.
4. Gilligan MA, Neuner J, Zhang X, Sparapani R, Laud PW, Nattinger AB. Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer. Am J Public Health. 97(3):539-44, 2007.
5. Harcourt KF, Hicks KL. Is there a relationship between case volume and survival in breast cancer? Am J Surg. 185(5):407-10, 2003.
Updated 11/17/10
